Damage From Long-Term SSRI Use - Opinions?

[Kiosk]

OK, I'm going to be very careful how I phrase this. For the record: I'm not an anti-psychiatry kook, I don't harbour any unrealistic paranoia about "Big Pharma" and I also don't have any underlying mental or physical illness about which I'm in denial. Furthermore, I'm not trying to use the JREF forums as a support group - this is just an appeal for some expert opinions on something which has happened to me, and scared me half to death. I'm looking for science rather than sympathy.

I began taking SSRIs in my mid twenties. I'd suffered from chronic mild-to-moderate depression for many years, had recently entered a particularly bad spell, and decided I needed help. The meds worked beautifully, no serious side-effects, and when I finished the six-month course I got the regulation two weeks of withdrawals (dizziness, derealisation, nausea and those stabbing electric shock sensations in the head, known to SSRI veterans as "zaps"), then went back to normal. Nothing out of the ordinary so far.

Less than a year later, I felt lousy again and decided to try an antidepressant long-term. This was the late 90s, and "maintenance treatment" with SSRIs had begun to be touted as the new hope for sufferers, so I got on the train. This time I was put on sertraline, alias Zoloft / Lustral (the doc had originally prescribed Effexor, but I felt so unstable on that particular medication that we decided to try a different one). 50mg of sertraline a day, then - equivalent to 20mg of Paxil or Prozac, or (I think) 10mg of Lexapro. It didn't work quite so well as my first go on antidepressants, but I definitely felt better than I did drug-free, so I stuck with it.

Four years later, the stuff didn't seem to be doing anything much anymore (except making orgasm rather troublesome), so I went back to the doctor, who suggested increasing the dose to 100mg of sertraline daily. Within two days of the dosage increase I felt better than I've ever felt in my life - what I now recognise as hypomania. Bouncing up and down on my bed doing star jumps at 3 in the afternoon because I felt so fantastic, etc. This is quite scary looking back (I've never, ever been diagnosed as bipolar, nor even displayed symptoms), but at the time it felt like a line of cocaine from which you never come down, and after the drudgery of depression it was fine with me. The hypomania settled down after a month or so, and I was back to the normal medicated version of myself - managing ok, depression more or less under control. So it went for another five years.

Then it started to wear off. Suddenly I felt more depressed than I'd ever been, and one or two of the med side effects had been getting noticeably worse, so I made the decision to wean off and try flying solo for a while, thinking I could always try another antidepressant if things were unbearable. Reduced my dose very gradually, as was now recommended by doctors. Unfortunately, rather than going back to normal, I went somewhere new and extremely frightening. I stuck it out, thinking it was just a rough withdrawal, but when I was still getting worse three months after being off all medication, to the point where I had to stop work, I knew something was seriously wrong.

The depression had reached monstrous proportions, way beyond anything I'd experienced before - still, there were plenty of possible explanations for that. What was harder to explain was why I now had a raging anxiety disorder, when I'd never suffered from anxiety in the past. This was shaking, eye-bulging, can't-leave-the-house anxiety, rootless and all-encompassing like a bad drug experience, without a break. What's more, I was experiencing near-psychotic derealisation, and was in a state of almost constant rage (I even got arrested for smashing a bottle of wine in the supermarket, an experience I don't even remember). Now sure, I was always a depressive, but very much the "stay at home and stare at the wall contemplating the futility of it all" type. This kind of raging mental illness was something completely new. I found myself waking up in the morning longing to die. I was crying hysterically at almost everything (and I've never been the type to cry at anything). I found that I could no longer spell correctly, and my reading comprehension level went down to near-zero. I tried to restart an SSRI, but within an hour of taking it I had a full-blown panic attack, and after the next day's dose I found myself smashing my head off the wall because I thought it was going to explode... so I stopped taking that immediately. And now I was stuck.

What makes this weirder are the physical symptoms. I lost two stone in weight (about 25 lbs) in six weeks, and during the same time period, my hair went Randi White at the sides, and began falling out in clumps at the top (I was 34). I could barely walk, the pain in my knee joints was so intense. My hands and feet went numb and ice cold several times a day, and I was also getting periodic numbness down the left side of my face. My sexual function was destroyed. All the veins on my arms and legs suddenly stood out like mooring rope, and stayed that way for months. I experienced constant tachycardia. All of these can, of course, be symptoms of extreme anxiety - something I have noted with interest - but they didn't seem to wax and wane in time with my anxiety. I saw various doctors, got checked out, and the same thing came back from all of them - you're clearly very ill and you do indeed have these symptoms, but we can't find anything specifically wrong with you. Why don't you go back on the antidepressants? I wanted to, but I was terrified. By four or five months off the pills, I'd stabilised to the point where I could just about function, but I was still in a very frightening place indeed.

It was around then, while Googling for further information, that I found discussion groups online full of people who were suffering something eerily similar. Everything I'd experienced was there. Even after I'd screened each website and weeded out those that were just some sort of front for quackery or Scientology, the facts were unavoidable. There were thousands of people out there, posting about their version of protracted withdrawal, the same stuff coming up over and over again. There were people who'd recovered after six months, and people who were still in the thick of it after three years. Some people's posts suggested they should probably never have come off their meds in the first place, but most were from ordinary suburban moms or stressed college students, many of whom had (incredibly) originally been prescribed these pills for insomnia or IBS - only to come out the other side in hell. I hung around long enough to convince myself this wasn't some elaborate hoax. These places were useful for validation and reassurance in that early period, but they weren't always happy places for a sceptic to hang out - a ton of woo in evidence ("have you tried homeopathy? It's natural"), a lot of pseudoscientific ranting (anger at SSRIs exploding into paranoiac resentment of "Big Pharma"), a very strong religious undercurrent on the American forums in particular (understandable among people of faith who are suffering horribly, but pretty sick-making to an atheist whose belief in the human "soul" as neurochemical in nature had just been rather strongly confirmed by having his "soul" turned inside out through a subtle rearranging of his neurochemistry). Some of the places offered proper peer-reviewed scientific papers on SSRI withdrawal for download, and while these were occasionally intriguing, they only really focused on the initial month following discontinuation, and were generally inconclusive. In most cases, the abstract could be summarised as "we took 15 people off their meds, 10 of them felt worse, 5 of those were really really sick, so we put them back on their meds and everything was alright again. We suspect this had something to do with the downregulation of seratonin receptors, but more research is needed."

This is why I'm asking if anyone here knows enough about neurology or psychopharmacology to offer some opinions on just what the hell is going on. It's now almost exactly two years since I stopped the pills, and while I've been gradually improving, I'm still a complete mess - I still can't work, and there are certain symptoms which are not getting any better at all, and are effectively ruining my life - and I'd really, really like to at least understand what could be happening. All I can find, aside from those papers mentioned above, is denial or woo. There are a few reputable psychiatrists who acknowledge long term problems after SSRI use (Joseph Glenmullen, David Healy etc) but they focus more on the fact that this happens, rather than why it happens or what can be done about it. Perhaps one of the more educated folk here could give me their two cents.

And I know I said I wasn't going to use JREF as a support group - but while you're at it, some general advice would be nice, as I'm way too deep in this to think about it objectively. Would I be more of an idiot to bite the bullet and try an SSRI again (and live with the terror of having to come off it again at some point in the future), or more of an idiot to just sit here for another two years waiting to miraculously "get better"? Life right now is close to unbearable, but I worry that the alternative could be even worse. What the hell is going on?

[ChristineR]

Well, I can you some insights.

Depression, despite what "Big Pharma" tells you is not an imbalance of serotonin in your brain. As best as anyone can figure out, depression is a group of changes in your brain structure and function caused by response to severe and unmitigating stress. The evolutionary purpose of depression probably has something to do with conserving resources when you're in a hopeless situation, but no one is sure. In any case it's all too clear that conditions in the modern world trigger depression when other sorts of reactions might be more useful.

There is no evidence that correlates depression with a lack of serotonin. Natural levels of serotonin seem to vary all over the place. Furthermore, there is no lifting of depression when you blast up the seratonin levels artificially with an SSRI. In fact, things get worse. People become anxious, agitated, fearful, even violent. (Sound familiar?)

What does happen (and this is good) is that over two to six weeks of artificially elevated seratonin in the brain, the structure and function of the brain changes. Apparently high levels of serotonin simulate whatever conditions would naturally trigger your brain to realize that the danger is past and there's no more need to withdraw and conserve resources.

When you stop taking the SSRI it's not clear what will happen. If your brain has down regulated natural production of serotonin, the changes may reverse. But if the lifestyle components that triggered the depression in the first place have gone, then maybe not.

Or you may get symptoms of low serotonin. And that may be followed by a rebound effect, and you then get symptoms of high serotonin.

One other thing that is known is that people who take SSRIs for many years sometimes gradually stop responding to them and the side effects (i.e., the primary negative effects from elevated serotonin levels) may actually get worse, possibly just because the anti-depressant effect is no longer canceling out the negatives.

My only other suggestion is that you try and find a specialist. If your serotonin regulation is destroyed beyond all hope, you may have no better choice than to go back on SSRIs. Or you can continue to hope it will gradually get better.

Disclaimer: I'm not an expert, just a person who has had some reason to read the research.

[Eos of the Eons]

I was on some antidepressants for years. I suffered no ill effects. In fact, I didn't know what it was like to not be depressed until I took them. My brain needed balancing, and antidepressants plus therapy got me that way. I couldn't do it with therapy alone, and I'm sure you can't do it on just antidepressants alone. You need both in many cases. I tried 3 antidepressants before I hit on one that actually helped me. Some are luckier to get help on the first one, some are not helped by any. You have to work with professionals (psychiatrists) to regulate doses and meds until you find something that works. The side effects should not interfere or make you worse. If the side effects make you worse, then the meds are obviously not working/helping, and something needs to be done to remedy that. Work with the doctor/psychiatrist and let them know if after a few weeks things aren't evening out. It takes a few weeks for side effects to subside and see if the meds help or don't help.

I never stopped responding to the one that worked. There were some subtle side effects that went away after I stopped taking it. I always saw a psychiatrist and a therapist regularly when I was on them. We gauged my progress together. The benefit is that I now know what life can be like without depression. I also learned to cope with stress better. I also learned to like myself and not be so hard on myself.


That said, this is really not the place to get opinions. Every case is different. Watch out for scientology propoganda pushed as "science" studies.

There is no way to measure what your brain needs, so some expirementing is required with both therapy and med types. That is why you need professionals, not boards like this that will have conflicting opinions. Your journey is a personal one, and no laypersons like us can give you any definitive direction for your case.

Good therapy is necessary, and I hope you explore all of your options there. In the end I was ready for group therapy with a good facilitator. I also had a great therapist (after shopping around for a while) before group therapy. There are structured and unstructured groups. Your therapist can help figure out what you need depending on what stage you are at in your journey.

Never mind the internet. Get real help, and a real supports.

Maybe it's not "just" depression, but bipolar or something. We don't know here. Only doctors and psychiatrists can point you in some direction.

[Soapy Sam]

OK, I'm going to be very careful how I phrase this.

And I know I said I wasn't going to use JREF as a support group - but while you're at it, some general advice would be nice, as I'm way too deep in this to think about it objectively. Would I be more of an idiot to bite the bullet and try an SSRI again (and live with the terror of having to come off it again at some point in the future), or more of an idiot to just sit here for another two years waiting to miraculously "get better"? Life right now is close to unbearable, but I worry that the alternative could be even worse. What the hell is going on?

Disagree. This is the most objective account of these effects I ever read and I've been reading a bunch this last year- possibly the same ones as yourself.

Have you documented this stuff? (Diaries etc), because if so, why not copy the data to research depts of the drug companies involved and to neuropsych departments of universities? You might elicit some information from one or two, beyond the sort of anecdote we can provide. Email is cheap.

When I read symptoms of chronic depression, I sometimesconclude I've been depressed all my life. (The home medical dictionary effect).
When I read accounts like yours, I reckon I can live with it. I've been watching a friend on Prozac for a year and I do not like what I see .

[Professor Yaffle]

You have to take into account that the changes you experienced may have been natural variations in how you felt and thet the anti-depressant wasn't doing anything much. You may have just hit a really deep depression that that particular AD wasn't touching. And the onset of anxiety may be something that would have occurred anyway even if you were untreated. I am not saying that the AD definitely had nothing to do with it, its just that we have a natural tendency to see patterns and need to feel something external is causing what we are feeling.

For example, I tried a few tricyclics and SSRI's which always seemed to work a little, then I would get worse anain and the dose would be increased and I would improve a bit and then get worse again etc. Then a few months later I would get better, and put my recovery down to the ADs. I then noticed that my onset was always in the autumn and my recovery in the spring and realised I had SAD - I still thought the ADs had worked though. I then suffered a particularly bad depression folowing the same pattern as usual, but due to a stressful time did not resolve in the spring. I eventually was referred to a psychiatrist who changed the class of my AD which worked much more effectively. He said that the previous ADs probably didn't work on me at all, and the initial improvements when dose was increased etc, were probably placebo effects. I know this case is vastly different to yours, but it is an example of misattributing the course of the illness.

The only research I have read on long term maintenance AD therapy has been in the elderly, bt I'm pretty sure it showed that it was superior to the usual length of treatment and then discontinuation for preventing relapse particularly for people at high risk of relapse.

I would definitely ask to ee a specialist if you are not already doing so, and try to get things under control again.

[Professor Yaffle]

This article might be helpful:

http://www.psychiatrist.com/pcc/pccpdf/v05s09/v64s1504.pdf

[Cainkane1]

I'm sorry you're having so many problems. I have chronic insomnia and anxiety attacks and I have to take trazadone to sleep. I shudder to think what would happen if the meds dried up.

[Dancing David]

OK, I'm going to be very careful how I phrase this. For the record: I'm not an anti-psychiatry kook, I don't harbour any unrealistic paranoia about "Big Pharma" and I also don't have any underlying mental or physical illness about which I'm in denial. Furthermore, I'm not trying to use the JREF forums as a support group - this is just an appeal for some expert opinions on something which has happened to me, and scared me half to death. I'm looking for science rather than sympathy.

I began taking SSRIs in my mid twenties. I'd suffered from chronic mild-to-moderate depression for many years, had recently entered a particularly bad spell, and decided I needed help. The meds worked beautifully, no serious side-effects, and when I finished the six-month course I got the regulation two weeks of withdrawals (dizziness, derealisation, nausea and those stabbing electric shock sensations in the head, known to SSRI veterans as "zaps"), then went back to normal. Nothing out of the ordinary so far.

Less than a year later, I felt lousy again and decided to try an antidepressant long-term. This was the late 90s, and "maintenance treatment" with SSRIs had begun to be touted as the new hope for sufferers, so I got on the train. This time I was put on sertraline, alias Zoloft / Lustral (the doc had originally prescribed Effexor, but I felt so unstable on that particular medication that we decided to try a different one). 50mg of sertraline a day, then - equivalent to 20mg of Paxil or Prozac, or (I think) 10mg of Lexapro. It didn't work quite so well as my first go on antidepressants, but I definitely felt better than I did drug-free, so I stuck with it.

Four years later, the stuff didn't seem to be doing anything much anymore (except making orgasm rather troublesome), so I went back to the doctor, who suggested increasing the dose to 100mg of sertraline daily. Within two days of the dosage increase I felt better than I've ever felt in my life - what I now recognise as hypomania. Bouncing up and down on my bed doing star jumps at 3 in the afternoon because I felt so fantastic, etc. This is quite scary looking back (I've never, ever been diagnosed as bipolar, nor even displayed symptoms), but at the time it felt like a line of cocaine from which you never come down, and after the drudgery of depression it was fine with me. The hypomania settled down after a month or so, and I was back to the normal medicated version of myself - managing ok, depression more or less under control. So it went for another five years.

Then it started to wear off. Suddenly I felt more depressed than I'd ever been, and one or two of the med side effects had been getting noticeably worse, so I made the decision to wean off and try flying solo for a while, thinking I could always try another antidepressant if things were unbearable. Reduced my dose very gradually, as was now recommended by doctors. Unfortunately, rather than going back to normal, I went somewhere new and extremely frightening. I stuck it out, thinking it was just a rough withdrawal, but when I was still getting worse three months after being off all medication, to the point where I had to stop work, I knew something was seriously wrong.

The depression had reached monstrous proportions, way beyond anything I'd experienced before - still, there were plenty of possible explanations for that. What was harder to explain was why I now had a raging anxiety disorder, when I'd never suffered from anxiety in the past. This was shaking, eye-bulging, can't-leave-the-house anxiety, rootless and all-encompassing like a bad drug experience, without a break. What's more, I was experiencing near-psychotic derealisation, and was in a state of almost constant rage (I even got arrested for smashing a bottle of wine in the supermarket, an experience I don't even remember). Now sure, I was always a depressive, but very much the "stay at home and stare at the wall contemplating the futility of it all" type. This kind of raging mental illness was something completely new. I found myself waking up in the morning longing to die. I was crying hysterically at almost everything (and I've never been the type to cry at anything). I found that I could no longer spell correctly, and my reading comprehension level went down to near-zero. I tried to restart an SSRI, but within an hour of taking it I had a full-blown panic attack, and after the next day's dose I found myself smashing my head off the wall because I thought it was going to explode... so I stopped taking that immediately. And now I was stuck.

What makes this weirder are the physical symptoms. I lost two stone in weight (about 25 lbs) in six weeks, and during the same time period, my hair went Randi White at the sides, and began falling out in clumps at the top (I was 34). I could barely walk, the pain in my knee joints was so intense. My hands and feet went numb and ice cold several times a day, and I was also getting periodic numbness down the left side of my face. My sexual function was destroyed. All the veins on my arms and legs suddenly stood out like mooring rope, and stayed that way for months. I experienced constant tachycardia. All of these can, of course, be symptoms of extreme anxiety - something I have noted with interest - but they didn't seem to wax and wane in time with my anxiety. I saw various doctors, got checked out, and the same thing came back from all of them - you're clearly very ill and you do indeed have these symptoms, but we can't find anything specifically wrong with you. Why don't you go back on the antidepressants? I wanted to, but I was terrified. By four or five months off the pills, I'd stabilised to the point where I could just about function, but I was still in a very frightening place indeed.

It was around then, while Googling for further information, that I found discussion groups online full of people who were suffering something eerily similar. Everything I'd experienced was there. Even after I'd screened each website and weeded out those that were just some sort of front for quackery or Scientology, the facts were unavoidable. There were thousands of people out there, posting about their version of protracted withdrawal, the same stuff coming up over and over again. There were people who'd recovered after six months, and people who were still in the thick of it after three years. Some people's posts suggested they should probably never have come off their meds in the first place, but most were from ordinary suburban moms or stressed college students, many of whom had (incredibly) originally been prescribed these pills for insomnia or IBS - only to come out the other side in hell. I hung around long enough to convince myself this wasn't some elaborate hoax. These places were useful for validation and reassurance in that early period, but they weren't always happy places for a sceptic to hang out - a ton of woo in evidence ("have you tried homeopathy? It's natural"), a lot of pseudoscientific ranting (anger at SSRIs exploding into paranoiac resentment of "Big Pharma"), a very strong religious undercurrent on the American forums in particular (understandable among people of faith who are suffering horribly, but pretty sick-making to an atheist whose belief in the human "soul" as neurochemical in nature had just been rather strongly confirmed by having his "soul" turned inside out through a subtle rearranging of his neurochemistry). Some of the places offered proper peer-reviewed scientific papers on SSRI withdrawal for download, and while these were occasionally intriguing, they only really focused on the initial month following discontinuation, and were generally inconclusive. In most cases, the abstract could be summarised as "we took 15 people off their meds, 10 of them felt worse, 5 of those were really really sick, so we put them back on their meds and everything was alright again. We suspect this had something to do with the downregulation of seratonin receptors, but more research is needed."

This is why I'm asking if anyone here knows enough about neurology or psychopharmacology to offer some opinions on just what the hell is going on. It's now almost exactly two years since I stopped the pills, and while I've been gradually improving, I'm still a complete mess - I still can't work, and there are certain symptoms which are not getting any better at all, and are effectively ruining my life - and I'd really, really like to at least understand what could be happening. All I can find, aside from those papers mentioned above, is denial or woo. There are a few reputable psychiatrists who acknowledge long term problems after SSRI use (Joseph Glenmullen, David Healy etc) but they focus more on the fact that this happens, rather than why it happens or what can be done about it. Perhaps one of the more educated folk here could give me their two cents.

And I know I said I wasn't going to use JREF as a support group - but while you're at it, some general advice would be nice, as I'm way too deep in this to think about it objectively. Would I be more of an idiot to bite the bullet and try an SSRI again (and live with the terror of having to come off it again at some point in the future), or more of an idiot to just sit here for another two years waiting to miraculously "get better"? Life right now is close to unbearable, but I worry that the alternative could be even worse. What the hell is going on?

There are many seperate issues eher and many of them are very cogent yet they seem to beg the question.

If ADs are perscribed to a very large group of people it is hard to do a retrospective study.

Take the hair loss for example, to do the retroactive on that you would have to find that a significant percentage of people taking SSRIs loose hair at a higher rate than the general (control) population.

Now that does not mean that a certain segment of people are not having that effect, it means that it would be hard to find. Then you would have to eliminate the other confounding factors that might be causing the target effect.

So a retropsective gathering of data is very hard.


It's now almost exactly two years since I stopped the pills, and while I've been gradually improving, I'm still a complete mess - I still can't work, and there are certain symptoms which are not getting any better at all, and are effectively ruining my life - and I'd really, really like to at least understand what could be happening.


This sounds really hard for you, have you condidered cognitive behavioral therapy? I don't want to pry but what do you feel is creating the barriers to your retturning to work?

[Dancing David]

Well, I can you some insights.

Depression, despite what "Big Pharma" tells you is not an imbalance of serotonin in your brain.

The serotonin depression is only for some people, it is not universal. Which is an error of marketing.

As best as anyone can figure out, depression is a group of changes in your brain structure and function caused by response to severe and unmitigating stress.

And that is demonstrated where?

I am not saying it is not one of many possibilities but the data don't say that. Some people appear to have stress related depression, some people seem to have lower thresholds for stress related depression and some people seem to have depression without stress.

The evolutionary purpose of depression probably has something to do with conserving resources when you're in a hopeless situation, but no one is sure.

It could have many things that go out of kilter and may not have a reprocutive benefit at all. It could have to do with circadian rythyms or just brain architechture. Perhaps humans aren't meant to live at the higher lattitudes or it could be a circadiam adjustment. It could also just be part of being alive.

In any case it's all too clear that conditions in the modern world trigger depression when other sorts of reactions might be more useful.

There is no evidence that correlates depression with a lack of serotonin.

True, it could be many things, however , the blocking of the receptor can cause a reregulation of the syste, and that can benefit the system of some people.

Natural levels of serotonin seem to vary all over the place. Furthermore, there is no lifting of depression when you blast up the seratonin levels artificially with an SSRI. In fact, things get worse. People become anxious, agitated, fearful, even violent. (Sound familiar?)

And that should be well known to the doctor , it can happen in people who will later benefit from the medication, but often is a serious side effect to be avoided. There are many issues there.

People who are depressed can often be dulled out from being overwhelmed, some will experience agitation and anxiety from an SSRI, some will just experience and increase in awareness of present symptoms as the medication has an effect.

But SSRIS, TCAs and SSNRIs should not be perscribed without short term monitoring and followup.



What does happen (and this is good) is that over two to six weeks of artificially elevated seratonin in the brain, the structure and function of the brain changes.

I am not sure that there is a strcutural change, there is a change in signal tansimission which allows some systems to reregulate.

Apparently high levels of serotonin simulate whatever conditions would naturally trigger your brain to realize that the danger is past and there's no more need to withdraw and conserve resources.

That theory while nice, seems rather unsupported at this time. in my case I have hightened arousal when i am depressed. I have more nergy, I don't sleep well, i am easily overwhelemed. There are people who have 'vegetative' symptoms, they are somewhere in the twenty to 40% of people with depression. But if I withdrew it was to avoid panic attacks.

So i would say that your theory can apply to a certain number of people but certainly is not overarching. I think the benefit to 'begetative' symptoms would apply more to people in winter.


When you stop taking the SSRI it's not clear what will happen. If your brain has down regulated natural production of serotonin, the changes may reverse. But if the lifestyle components that triggered the depression in the first place have gone, then maybe not.

Or you may get symptoms of low serotonin. And that may be followed by a rebound effect, and you then get symptoms of high serotonin.

One other thing that is known is that people who take SSRIs for many years sometimes gradually stop responding to them and the side effects (i.e., the primary negative effects from elevated serotonin levels) may actually get worse, possibly just because the anti-depressant effect is no longer canceling out the negatives.

My only other suggestion is that you try and find a specialist. If your serotonin regulation is destroyed beyond all hope, you may have no better choice than to go back on SSRIs. Or you can continue to hope it will gradually get better.

And a general medical workup, there are many things which cause depressive like symptoms.


Disclaimer: I'm not an expert, just a person who has had some reason to read the research.

The real issue to me is that while there are two main pathways im[plicated in depression the acetyl choline/dopamine and the seortonin. they are not the only pathways, so eventually our pharmacology will have to become much more graded and diverse(Not likely in the mass production world)

[Professor Yaffle]

I agree about serotonin not being the only pathway implicated in depression. It seems that SSRIs don't work for me at all and I need antidepressants which act on noradrenaline.

But perhaps this side discussion (interesting though it is) would be better split off from the main thread to avoid derailing it away from the concerns of the OP?

[Sleepy]

I've been on Effexor XR 75mg for a couple of years. It's an SNRI so quite different to SSRIs, but here's my anecdote regardless.

Stopped once a few months back, but after a couple of weeks started getting agitated, then started getting enraged for any reason at all, constantly feeling pissed off. So went back on for 140 days (5 x 28 pill boxes). Soon settled down, happy as Larry again.

Recently stopped again, about three weeks ago. This time just a bit more irritable, but I can live with it. If it gets worse I can always go back on again. IANA doctor but maybe it might take several attempts before you can quit for good?

[Professor Yaffle]

Effexor XR is the only AD I have had problems coming off, but it has been the only one that was effective too (in combination with mirtazepine). So I would go back on it immediately if needed. The withdrawal effects were manageable when I tapered the dose, only going down by 25mg at a time, every couple of weeks.

[calebprime]

... This is the most objective account of these effects I ever read and I've been reading a bunch this last year- possibly the same ones as yourself.

Have you documented this stuff? (Diaries etc), because if so, why not copy the data to research depts of the drug companies involved and to neuropsych departments of universities? You might elicit some information from one or two, beyond the sort of anecdote we can provide. Email is cheap.

When I read symptoms of chronic depression, I sometimesconclude I've been depressed all my life. (The home medical dictionary effect).
When I read accounts like yours, I reckon I can live with it. I've been watching a friend on Prozac for a year and I do not like what I see .

This is basically my position/opinion as well.


OK, I'm going to be very careful how I phrase this. For the record: I'm not an anti-psychiatry kook, I don't harbour any unrealistic paranoia about "Big Pharma" and I also don't have any underlying mental or physical illness about which I'm in denial. Furthermore, I'm not trying to use the JREF forums as a support group - this is just an appeal for some expert opinions on something which has happened to me, and scared me half to death. I'm looking for science rather than sympathy.

...

If it's any consolation, you're at least capable of a very intelligent post. My sympathies. I believe that some of the distress you've experienced is a result of long-term SSRI use, but not all of it. Oh, and welcome.

Some stuff you already know:

Dr. Glenmullen is perhaps more moderate than Peter Breggin.

www.prozacbacklash.com/


There's also Karp Is it Me or My Meds?

www.hup.harvard.edu/catalog/KARISI.html




I was on some antidepressants for years. I suffered no ill effects. In fact, I didn't know what it was like to not be depressed until I took them. My brain needed balancing, and antidepressants plus therapy got me that way. I couldn't do it with therapy alone, and I'm sure you can't do it on just antidepressants alone. You need both in many cases. I tried 3 antidepressants before I hit on one ...

Never mind the internet. Get real help, and a real supports.

Maybe it's not "just" depression, but bipolar or something. We don't know here. Only doctors and psychiatrists can point you in some direction.


In my case, trying to improve my lot with medication and a relationship with a therapist wasn't the answer. The therapists have provided some comfort and personal contact--which relieved my loneliness, but that's all. They have never shown me anything I didn't know already. Prozac (in a brief trial) made me hypomanic, but that's a long story.

The complementary opinion to Eos: Do what you think is best. Let your conscience be your guide. Listen to your still small voice. It takes a long, long time to build a relationship with someone to the point where he/she can help, and even then, he/she may not be able to help.

Bottom line: Different people have different needs for self-reliance vs. relationships with doctors, therapy, and group support.

[ChristineR]

The serotonin depression is only for some people, it is not universal. Which is an error of marketing.

I think it goes further than that. There's no good correlation between say, serotonin levels and whether a person will react to an SSRI. We're talking about a constellation of changes which may or may not include low neurotransmitter levels.

And that is demonstrated where?

I am not saying it is not one of many possibilities but the data don't say that. Some people appear to have stress related depression, some people seem to have lower thresholds for stress related depression and some people seem to have depression without stress.

It could have many things that go out of kilter and may not have a reprocutive benefit at all. It could have to do with circadian rythyms or just brain architechture. Perhaps humans aren't meant to live at the higher lattitudes or it could be a circadiam adjustment. It could also just be part of being alive.



Well, define stress. There's no doubt that our brains change in reaction to external stimuli, and there's also no doubt that some people enter depression for no obvious reason. But given the prevalence of depression it must have some evolutionary purpose; there must be some sort of environmental situation where it is beneficial to be depressed. I can think of no other explanation. It's clear though that the spiral of depressive changes are not always triggered by what a reasonable person might consider to be stressful, and in many cases no trigger is ever identified. It might be an accidental sort of thing that just happens to trigger the depression, or it might be something that would have been associated with some sort of stress a remote ancestor but not cannot be considered stressful anymore.


True, it could be many things, however , the blocking of the receptor can cause a reregulation of the syste, and that can benefit the system of some people.

Agreed.

And that should be well known to the doctor , it can happen in people who will later benefit from the medication, but often is a serious side effect to be avoided. There are many issues there.

People who are depressed can often be dulled out from being overwhelmed, some will experience agitation and anxiety from an SSRI, some will just experience and increase in awareness of present symptoms as the medication has an effect.


But SSRIS, TCAs and SSNRIs should not be perscribed without short term monitoring and followup.


Should be, but antidepressants are routinely prescribed by general practitioners to children, people who are not depressed, and even pets. Of course this has been changing in recent years as there was a spate of suicides and murders by people who had been taking SSRIs for a short time, and now we are in a backlash.

I am not sure that there is a strcutural change, there is a change in signal tansimission which allows some systems to reregulate.

I consider this a structural change. What other sort of change would it be? The word structural is pretty vague here, but it encompasses just about every way the brain can change.

That theory while nice, seems rather unsupported at this time. in my case I have hightened arousal when i am depressed. I have more nergy, I don't sleep well, i am easily overwhelemed. There are people who have 'vegetative' symptoms, they are somewhere in the twenty to 40% of people with depression. But if I withdrew it was to avoid panic attacks.

So i would say that your theory can apply to a certain number of people but certainly is not overarching. I think the benefit to 'begetative' symptoms would apply more to people in winter.

Except that your symptoms sound like a natural adaption to unmitigating stress to me as your body attempts to deal with the stressors. The heightened arousal increases your chances of dealing with the danger. If you were to keep up that state of heightened arousal you would become ill and unable to function. And withdrawing to avoid panic is an obvious example of a behavior which makes more sense in a primate society than in modern society.


And a general medical workup, there are many things which cause depressive like symptoms.

Easier said than done, many (I venture to say most) doctors would refuse to treat someone with his history other than putting him back on SSRIs. If he didn't improve they increase his dose, and if they didn't improve after that they'd try another SSRI, and if that didn't help he have lost another year of his life and they might actually do some other medical tests. And it's kind of hard to shop for a sympathetic doctor when you are that ill.


The real issue to me is that while there are two main pathways im[plicated in depression the acetyl choline/dopamine and the seortonin. they are not the only pathways, so eventually our pharmacology will have to become much more graded and diverse(Not likely in the mass production world)

Agreed, we are a long way from solving this problem.

[BenBurch]

The only damage I really worry about is heart valve damage.

[Myshkin]

Furthermore, there is no lifting of depression when you blast up the seratonin levels artificially with an SSRI. In fact, things get worse. People become anxious, agitated, fearful, even violent. (Sound familiar?)


What does happen (and this is good) is that over two to six weeks of artificially elevated seratonin in the brain, the structure and function of the brain changes. Apparently high levels of serotonin simulate whatever conditions would naturally trigger your brain to realize that the danger is past and there's no more need to withdraw and conserve resources.


Maybe I'm stupid, but these statements appear contradictory. If there is no lifting of depression with artificially-boosted SSRIs, how can high levels of seratonin produce the hypothesized "non-depression" state? Clinically, it matters not whether the non-depression state is caused directly by high levels of seratonin or by brain changes caused by the high level of seratonin. One cause is simply more proximate than the other.

[Myshkin]

But given the prevalence of depression it must have some evolutionary purpose; there must be some sort of environmental situation where it is beneficial to be depressed.

Not really. It could be a by-product of a state, process, or structure that is a selective advantage, and the net selective pressure on the two combined is positive. Depression on its own could even be selected against, but if the thing it is inextricably linked to is sufficiently selected for, there will be little to no selection against depression.

An analogy: Cars are beneficial. They have been societally selected for. In other words, we choose to have them for our benefit. Exhaust and pollution are linked to (most) cars, which is generally a detriment. Exhaust pollution does not serve any net positive, yet it is still extant. In the same way, depression may not serve (or even have served) any net reproductive benefit yet it is still extant.

[BenBurch]

... Depression on its own could even be selected against, ...

As decreased sex drive is almost universally reported, this is certain!

[Dancing David]

I think it goes further than that. There's no good correlation between say, serotonin levels and whether a person will react to an SSRI. We're talking about a constellation of changes which may or may not include low neurotransmitter levels.

I don't know why the pharma ads keep focusing on that. there is either an overresponse or an underresponse in the system. theory used to be that depression was caused by overactivity of certain reas.

The level of serotonin is not the issue, it is how the postsynaptic receptor responds to it.




Well, define stress.

A state of exhaustion caused by constant arousal of the sympatheic system.

There's no doubt that our brains change in reaction to external stimuli, and there's also no doubt that some people enter depression for no obvious reason. But given the prevalence of depression it must have some evolutionary purpose; there must be some sort of environmental situation where it is beneficial to be depressed.

That is a discussion for another thread. the reason depression exists may or may not be that it is associated with reproduction. It can be associated with a trait that is involved in reproduction.

I can think of no other explanation.

Systems are out of whack for a lot of reasons.

It's clear though that the spiral of depressive changes are not always triggered by what a reasonable person might consider to be stressful, and in many cases no trigger is ever identified. It might be an accidental sort of thing that just happens to trigger the depression, or it might be something that would have been associated with some sort of stress a remote ancestor but not cannot be considered stressful anymore.

Or in my case , nothing at all.

I also have the stress response.





Agreed.



Should be, but antidepressants are routinely prescribed by general practitioners to children, people who are not depressed, and even pets. Of course this has been changing in recent years as there was a spate of suicides and murders by people who had been taking SSRIs for a short time, and now we are in a backlash.

And the sad thing is that the suicide rate has doubled since the 'black box warning' and the decrease in childhood treatment. (Rate for young people has doubled.)




I consider this a structural change. What other sort of change would it be? The word structural is pretty vague here, but it encompasses just about every way the brain can change.

depends , I view har ware as structure, and associative connections as software.



Except that your symptoms sound like a natural adaption to unmitigating stress to me as your body attempts to deal with the stressors.

I would say it is just what it is, it is likely to be associated with successful trait when there is only half an expression but detriment when there is full expression.

I can be off work and low stress for three months and still have disturbed sleep and anxiety.

The heightened arousal increases your chances of dealing with the danger.

Not when I am fighting OCD and intrusive thoughts.

If you were to keep up that state of heightened arousal you would become ill and unable to function. And withdrawing to avoid panic is an obvious example of a behavior which makes more sense in a primate society than in modern society.

it makes sense in any society, if other people are your panic trigger.





Easier said than done, many (I venture to say most) doctors would refuse to treat someone with his history other than putting him back on SSRIs.

then that is bad medicine, most doctors want at least a chem-20 and blood sugar when you come back after an extended hiatus. Some practioners are better than others.

If he didn't improve they increase his dose, and if they didn't improve after that they'd try another SSRI, and if that didn't help he have lost another year of his life and they might actually do some other medical tests. And it's kind of hard to shop for a sympathetic doctor when you are that ill.

maybe you have a lot of old practioners in your area, most of the clinics here want you to have the usual blood panels, especially when you are having symptoms like your hair coming out in clumps.





Agreed, we are a long way from solving this problem.

[Dancing David]

Maybe I'm stupid, but these statements appear contradictory. If there is no lifting of depression with artificially-boosted SSRIs, how can high levels of seratonin produce the hypothesized "non-depression" state? Clinically, it matters not whether the non-depression state is caused directly by high levels of seratonin or by brain changes caused by the high level of seratonin. One cause is simply more proximate than the other.


It would help to understand the mechanisms involved here, which is why the pharma ads are misleading.

The SSRI blocks the 'reuptake' of the serotonin after it is in the postsynaptic cleft. They are selective serotonin reuptake inhibitor.(MAOI do as well but effect more neurotransmitters). So unlike psilocyby which is a serotonin aggonist (loose bound to the receptor) or LSD which is a serotonin agonist (binds tightly to the receptor) you are not introducing an artificial agent that binds to the post synaptic receptor (and auto receptors as well) you are just increasing the availability of the serotonin in the postsynaptic cleft. And it may not really create a high level of serotonin, it just creates a higher level.

Diffenet people have different depressions as well, i tend to have an agitated depression, some people have a more vegetative depression.

One person will be depresssed and more active, another will be depressed and less active.

[Kiosk]

Thanks for the replies (and I'm finding the general discussion that's been sparked off pretty interesting, too).

Just to clarify: I've had a ton of blood tests and the like. I've had my thyroid checked, hormone levels, blood sugar, pretty much everything the creaking British NHS can provide. Everything has come back 100% normal, apart from a mild iron deficiency which could have been linked to the hair loss; a course of iron pills seemed to slow it down somewhat. I remember a doctor examining me when the knee pain was at its height, and being baffled. I had all the symptoms of rheumatoid arthritis - worse in the cold, worse the day before it rained, everything - but no swelling, in fact no physical signs of arthritis at all. It's all very interesting medically, but rather grim to live through.

My own suspicion - based on a hunch, rather than anything more - is that most of the physical symptoms are a result of the extreme, constant anxiety. Things like the joint pain, which is not generally an anxiety symptom but could be linked to seratonin's role in joint movement, have faded over time, while other symptoms which are often associated with high anxiety have not. My own research has been limited by the fact that I have no background in biology / neurology / psychiatry, so there's an element of scrabbling around in the dark, but the most interesting thing I turned up was the fact that these post-SSRI symptoms are almost exactly paralleled in people with Advanced Panic Disorder that has been untreated and progressed to dysautonomia. Could it be that "something" (i.e. severe disruption of neurotransmitter activity) has mimicked severe panic disorder, and caused knock-on effects in the CNS? I learned that folks with APD often find their condition is worsened by an SSRI - compare and contrast with that extreme adverse reaction when I initially tried to recommence treatment while in the thick of it - and that they are often hypersensitive to any kind of stimulant or intoxicant (I had to give up caffeine, and have only recently been able to drink an occasional glass of wine without messing myself up for three days). The only drug that seems to work on them is a benzo, and while I used it only occasionally to avoid dependence, a little Valium seemed to smooth things out slightly without any negative effects, on occasions when I've really needed it. Looking at the SSRI discussion forums seems to add weight to this, as pretty much everyone else has the same oversensitivity to drugs of any kind, and the same positive response to benzos. The frustrating thing, of course, is that this is just a thought, and there's really no way of proving or disproving it.

In the past year, my cognitive functioning has improved a lot, which is why I'm now able to write coherently. The problem is, I used to work as a freelance journalist and critic, and I still haven't got to a point where I can do that comfortably or reliably because it requires a level of mental clarity I haven't yet regained, as well as a lot of motivation to seek out work, etc. I still have weeks (more or less at random) where I can't get off the floor and can barely form sentences, so I'd be taking a huge chance to accept any work with a deadline. The problem is that while some things are getting better, others aren't, and indeed haven't improved at all over the past two years. Aside from the mood issues, the worst of these has been the sexual dysfunction. I don't have the total loss of sex drive reported by some men who've taken SSRIs (my sex drive is as robust as ever, which is part of the problem), but I do have three different kinds of sexual dysfunction which I shan't share with you here, but as you can probably imagine, it's hellish - especially when two of them can't be treated with any drugs other than SSRIs. What's more, looking at the online reports from people who've suffered sexual problems after taking antidepressants (even with appropriate scepticism), the prognosis doesn't appear to be good at all. In all honesty, if that stuff isn't going to go away - even if I made a 100% recovery in all other areas - life isn't going to be worth living. However tough I am about the experience as a whole, I fear that it will be this that finally forces me back onto the drugs, and into an uncertain future. For now, I'm just trying to hang on.

By the way, I have to take issue with the idea that suicide rates in young people have risen since the black box warnings. This is one example of "Big Pharma" actually being very naughty indeed - I may not be paranoid, but I'm acutely aware of what's genuinely wrong with the pharmaceutical industry. Drug companies may not be evil entities hellbent on suppressing the magical cures of Mr Trudeau so they can push autism injections, but when it comes to SSRIs they have often played fast and loose with the facts to avoid hurting profit margins, and engaged in data mining to shame a Geller apologist (GlaxoSmithKline's handling of the clinical trials for Paxil is a pretty chilling story). The last released youth suicide figures are actually for the period immediately before the introduction of the warnings, during which prescription rates in fact rose. Trying to push these as "proof" that black box warnings cause suicide is a pretty low trick on their part, if you ask me.

Anyway, I appreciate the responses - and I appreciate that this is not something that can be solved online. It's just that, after wading through oceans of propaganda (both pro and anti medication), it's good to hear people who have some idea what they're talking about, talking honestly. I'm about to read through the links provided, and then ponder on what to do next (because somehow, listening to Johnny Cash's version of "I See A Darkness" over and over again isn't helping).

[Yiab]

The depression had reached monstrous proportions, way beyond anything I'd experienced before - still, there were plenty of possible explanations for that. What was harder to explain was why I now had a raging anxiety disorder, when I'd never suffered from anxiety in the past. This was shaking, eye-bulging, can't-leave-the-house anxiety, rootless and all-encompassing like a bad drug experience, without a break. What's more, I was experiencing near-psychotic derealisation, and was in a state of almost constant rage (I even got arrested for smashing a bottle of wine in the supermarket, an experience I don't even remember). Now sure, I was always a depressive, but very much the "stay at home and stare at the wall contemplating the futility of it all" type. This kind of raging mental illness was something completely new. I found myself waking up in the morning longing to die. I was crying hysterically at almost everything (and I've never been the type to cry at anything). I found that I could no longer spell correctly, and my reading comprehension level went down to near-zero. I tried to restart an SSRI, but within an hour of taking it I had a full-blown panic attack, and after the next day's dose I found myself smashing my head off the wall because I thought it was going to explode... so I stopped taking that immediately. And now I was stuck.

What makes this weirder are the physical symptoms. I lost two stone in weight (about 25 lbs) in six weeks, and during the same time period, my hair went Randi White at the sides, and began falling out in clumps at the top (I was 34). I could barely walk, the pain in my knee joints was so intense. My hands and feet went numb and ice cold several times a day, and I was also getting periodic numbness down the left side of my face. My sexual function was destroyed. All the veins on my arms and legs suddenly stood out like mooring rope, and stayed that way for months. I experienced constant tachycardia. All of these can, of course, be symptoms of extreme anxiety - something I have noted with interest - but they didn't seem to wax and wane in time with my anxiety. I saw various doctors, got checked out, and the same thing came back from all of them - you're clearly very ill and you do indeed have these symptoms, but we can't find anything specifically wrong with you. Why don't you go back on the antidepressants? I wanted to, but I was terrified. By four or five months off the pills, I'd stabilised to the point where I could just about function, but I was still in a very frightening place indeed.

This one sounds similar to something a friend of mine had, but yours is more serious. He was almost constantly depressed as well as serious anxiety problems. His anxiety was extreme enough that several doctors had reported his heart was degenerating and that he would die in a matter of a few years (he was 20 at the time). Normally, I would have expected his anxiety to be a result of his heart condition or both to be caused by some deeper problem, but I attribute his heart condition to his anxiety now because of what happened later.
Over the course of a couple of years, I taught him how not to worry about things too much and how to relax regularly. He gradually improved and became less anxious, but his depression mostly remained (it got a little better, but not much). His pathological fear of spiders began to recede to the point where he could actually hear the word without visibly shuddering. When doctors later looked at the condition of his heart, they were at a loss to explain that it had begun increasing in mass and was looking healthier than ever.

Of course, I'm not trying to tout any miracle cure or other garbage, all of this is just an anecdote about the kind of damage severe anxiety can cause and how sometimes the simplest of things (like having a good friend around to advise you) can help in enormous ways.
Of course, he never took SSRIs, but I'd guess that the way the story of my friend can be relevant to your situation is that the serious side-effects of severe anxiety don't have to wax and wane with the actual anxious feelings in the short term - they may not start to clear up until after your anxiety has been reduced for a protracted period of time.

I've been on Effexor XR 75mg for a couple of years. It's an SNRI so quite different to SSRIs, but here's my anecdote regardless.

Stopped once a few months back, but after a couple of weeks started getting agitated, then started getting enraged for any reason at all, constantly feeling pissed off. So went back on for 140 days (5 x 28 pill boxes). Soon settled down, happy as Larry again.

Recently stopped again, about three weeks ago. This time just a bit more irritable, but I can live with it. If it gets worse I can always go back on again. IANA doctor but maybe it might take several attempts before you can quit for good?

I've been repeatedly told by doctors that dropping off of an antidepressant suddenly makes all similar antidepressants less likely to work in the future (I think it was either 50% or 80% chance of failing next time). I don't think this applied to weaning off of them, but I do vaguely recall claims that there was some reduction in efficacy when returning to a previously effective antidepressant.
I bring this up to suggest that you ask your doctor about the right way to go off a medication if you've decided to do that.

[Dancing David]

This is not addressed to any poster in particular. It is a vent from years of working in mental health, domestic violence and crisis intervention.




Here is one citation and the study I mentioned. It is for 2004, the year the warning was given.
http://pediatrics.aappublications.org/cgi/content/abstract/119/2/345?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&fulltext=suicide&searchid=1&FIRSTINDEX=0&volume=119&issue=2&resourcetype=HWCIT

I do not mean for this to sound cynical but:

Who here has worked with families and kids in crisis?

It is not big pharma that is pushing kids into treatment.

It is parents.

They have children that have a mental illness, behavioral disorders or both.

Those who want to whine about over medicating children should get off their duffs and go work at their local mental health center.

What do you do for a child who sleeps two hours a night and has rages where they batter their siblings?
What do you do for a teenager who looks depressed and talks about killing themselves?
What do you do for a child who is suspended from school for fighting everyday?
What do you do for a child who does not have autism but still goes into rages and destroys everything in the house?

These are all real things that happen everyday.

They are not a myth, they are not a story made up by big pharma.

Some kids act out because of trauma in the family, and they should get cognitive behavioral therapy.

Some kids act out because they are budding antisocial on their way to a life of crime.

Some kids act out because they are way alcoholic or drug dependant.

Some kids acts out because they have a florid mental illness.

Some kids act out because of all of the above or some of the above.

Kids do not act out because big pharma told them to.

I will tell you this as someone who was a gate keeper and had to make referrals to the hospitals and the state screening agency.

Services are overwhelmed, there are many more people that the system can serve.

There are young people at risk of harming themselves, there are young people at risk of harming others, and they get deflected because there is not enough money. The standard for child intervention has reached almost as high a bar as that for adults. There are children who do kill themselves, there are children who harm others. And they are not served because the state would rather build new sports stadiums and high prestige college buildings that open a new treatment center for children.


Then there is the privacy issue. These parents who say "Antidepressants made my child suicidal or homicidal.", that may be true in the same level as other side effects.

But here is what you don't know.

Doctor shopping, treatment shopping and juvenile privacy. Parents who don't like an accurate diagnosis will go someplace else. Parents who don't like an effective treatment will go some place else.

Parents will say that "It was the antidepressants" when their child has a history of multiple batteries and multiple suicide attempts before they ever had treatment. The same mechanisms that apply to drug use and criminal behavior apply to mental health issues.

People don't want to admit their child has a problem, people minimize the problem, people deny the problem, people cover the problem, and people lie about the problem.


This is a real issue in mental health treatment folks, you will ask them in the assessment "Has your family member ever threatened others? Has you family member ever tried to harm others?"

and then two years later when the family wants someone hospitalized they will tell you "oh yeah by the way ,four years ago they tried to choke mom with the phone cord, we had to restrain them and cut the phone cord."

And this is the same family member who lied to you in the assessment knowing full well what had happened.


NOW HERE IS A BIG CAVEAT:

There kids who are forced into treatment as the 'identified client', they are the victims of trauma, they live in a chaotic family, they have alcoholic parents, they have perpetrators parents.
And guess who gets to go see the doctor, is it the sick adult?
No.
Is it the criminal adult?
No.
Is it the adult who breaks furniture and chokes people on the weekend?
No.
Is it the adult that leaves their four year old unsupervised while they go and get drunk at the bar?
No.
Is it the parent who is so desperate to go out on the town the leave their child with Uncle Chester?
No.

It is the child who is the victim that gets to go get treatment.

And the family sits there is the assessment and they deny, they minimize and outright lie about what is happening in the family.

[Soapy Sam]

Kiosk- This may seem an unorhodox suggestion on a sceptic board, but have you tried some form of physical relaxation such as yoga?

I'm wondering if some of the joint / muscle pain may be posture related due to stress.

Example- I used to get headaches when driving in winter which I blamed on the low sun which always seems to be in my eyes. (I'm at 56 deg N). I also sometimes got toothache. I also got it on dull days. I finally twigged- I was screwing up my eyes and tensing my jaw driving into the sun. I had got so used to doing this, I had started doing it as soon as I got in the car, even on dull days. A minor stress (the sun) had caused me to create a chronic stress in myself which was generating real physiological effects.
The head and jaw pains were wholly self induced.
I now have to remember consciously to relax - even to drive with an idiot grin which relaxes the facial muscles (and then remember to stop before THAT gets sore, or I get arrested).

The thing about yoga (or tai chi, or practically any form of structured gentle exercise is less that it "gets you fit" than that it can move subconscious postural habits into your conscious awareness, so you can change them if they are causing problems. Anything that stretches opposed muscle pairs is good.
Just stretching is fine, if you do it scientifically.
(This ain't magic fairy stuff. It's just learning how to unlearn bad postural habits that really can cause chronic problems. If you are sure you have no such problems, then this won't help, but if you have arthritic type pain without inflammation it's certainly worth checking. If you do have a posture induced stress, you'll get the inflammation too, eventually, because you'll be overloading a joint or other soft tissue).
Give it some thought. If you have no problems of this sort, it can't hurt to check.
You might even try a visit to a sports physiotherapist, dance coach or even an Alexander Technique instructor. These people look at lots of bodies and are good at spotting alignment problems. Hell, it can't hurt and if it helps you can write a self help anti-pharma book and get rich. I'll send you my account details.

[illogical]

i would exercise caution. the neurolepics/antipsychotics are among the worst. but can you imagine 1% of the population walking around the city without such meds?

ssris seem to cause less short term issues.

thinking about it logically -- researchers are mucking with the most advanced machine in this area of the galaxy. i bet there are long term issues which will show up in 20 year studies.

two questions:

how would life be without meds?
is it worth the risk?

my answer to the second is yes, depending on the individual.

[fredcarr]

It is not big pharma that is pushing kids into treatment.

It is parents.

Seems a bit simplistic. I won't deny parents have pushed their kids into treatment but to also say big pharma isn't is to ignore some obvious marketing campaigns by big pharma.

Fred

[fredcarr]

Two great books to read on this subject are "Mad in America" by Robert Whitaker and "The Truth about the Drug Companies" by Marcia Angell.

Fred

[BenBurch]

I do not mean for this to sound cynical but:

Who here has worked with families and kids in crisis?

It is not big pharma that is pushing kids into treatment.

It is parents.

BS.

Its SCHOOLS.

I know for fact that the local schools will tell a parent that a child is not to return to school unmedicated. Period.

[SDC]

BS.

Its SCHOOLS.

I know for fact that the local schools will tell a parent that a child is not to return to school unmedicated. Period.

It's both or either. I have a relation who has had both her kids put on anti-depressants... I'm not sure how old the elder boy was (he's now 21, still on them) and the younger was on them by 11. I frankly think it is a control issue for her. When the elder boy was 16, I remember her calling his shrink to check in after his latest therapy session, and she had a long cell phone conversation in a store sharing it with me (well, I fled) and others. I've asked therapists I know and they are all surprised at what she is doing.

She is very strange on this topic; she herself is a therapist (not an MD) and while we love her as family we've learned never to suggest that her boys ever do anything wrong or are in anyway imperfect (which is kind of contradictory, now that I think of it). The rest of the family is like "normal" parents who do a lot of eye-rolling and make a lot of jokes about their own kids, but not her. ("We" in the above passages = self+spouse, not editor or royalty.)

[Dancing David]

double post

[Dancing David]

Seems a bit simplistic. I won't deny parents have pushed their kids into treatment but to also say big pharma isn't is to ignore some obvious marketing campaigns by big pharma.

Fred


Sure, I agree, but there is this HUGE PROBLEM, people deny that mental illness exists, all the time in almost every area of life.

So when most people get help, and I don't mean the parent who wants their child to get special ed because they got a 'C', they are in a desperate situation. They usually have family members who have been battered, property consistantly destroyed or a failed suicide attempt before they get their kid help.

And then there is this huge percentage of family and friends who will tell them they are doing the wrong thing for their child.

Despite the fact that their child sleeps only two hours a day and goes into uncontrollable rages, or has multiple suicide attempts.

[Dancing David]

Two great books to read on this subject are "Mad in America" by Robert Whitaker and "The Truth about the Drug Companies" by Marcia Angell.

Fred


try Surviving Scizophrenia by E. Fuller Torrey.

I am not saying that we do not live in a consumer driven materialistic society, just that there are children who have a mental illness. And it is not the fault of the medication or the parents.

[Dancing David]

BS.

Its SCHOOLS.

I know for fact that the local schools will tell a parent that a child is not to return to school unmedicated. Period.


Tell you what, next time I have to deal with a student who is throwing tables and trying to batter me because they didn't take their medication, you come down and tell me that big pharma is at fault. Hmmkay?


Then work with the school board to keep them from being expelled, and then you can visit the morgue with the bodies of the kids who kill themselves.

Ever met someone after a suicide attempt? It can be kind of grisly, especialy when they have cut themselves, although the lavage with charcol is kind of icky as well. Ligature bruises are really ugly. And then watching somebody with extreme nausea from an overdose is not so fun.

[calebprime]

We've wandered from the original purpose of the thread.

There's probably a psychological reason for this derail--passions run high on the general issue of medication and mental health, so DD among others is sort of changing the subject to something he feels passionate about.

I have nothing but respect for DD's real-world experience--far from the world I know, a world of relative wealth, privilege and education. He's also quite capable of talking about the gray areas when he chooses.

Nevertheless, the accounts (anecdotes) of many, many users of medications--positive and negative--should be part of how we collect knowledge about the subject. That's why I like books like the ones by Karp.

A person has direct access to how he/she feels--it's not like these people are talking about UFOs.

One further point--in my school system (Brookline, Mass.), the teachers and staff can recommend medication, but they can't demand it. We've been treated mostly with courtesy, and everyone seems to want what's best for our child. There's a range of opinion from pro-medication to no-medication, but no overbearing pressure.

Oh, we did hear from one teacher that our kid should be put on "anti-anxiety" medication--but when I asked specifically what she meant, it turned out she had no real idea what she was talking about. I've encountered this rather empty attitude before--it's the attitude that treatment is available and should be sought--without any actual substance (in both senses) behind it.

At least in our neck of the woods, schools aren't to blame. Neither are we, neither is our kid. (Our problems are mild compared to what DD is talking about.)

Only time will tell about SSRIs.

And the issue of long-term use is perhaps the most difficult to sort out.

[calebprime]

dbl post

[Dancing David]

Hiay Caleb,

That sounds terrible, anxiety is usually very easy to see in young adults. You have to be patients in listening to what they say.

BTW I am not saying that any person should have to take medication, children and young adults need a very careful assesment and diagnosis with regular monitoring (two weeks at first and then monthly and titration to the best dose with explanations of side effects and contraindications).

[BenBurch]

("We" in the above passages = self+spouse, not editor or royalty.)

I usually tell people that I am speaking for my colony of eyelash mites when I use "we" mistakenly and am called on it.

[BenBurch]

Tell you what, next time I have to deal with a student who is throwing tables and trying to batter me because they didn't take their medication, you come down and tell me that big pharma is at fault. Hmmkay?


Then work with the school board to keep them from being expelled, and then you can visit the morgue with the bodies of the kids who kill themselves.

Ever met someone after a suicide attempt? It can be kind of grisly, especialy when they have cut themselves, although the lavage with charcol is kind of icky as well. Ligature bruises are really ugly. And then watching somebody with extreme nausea from an overdose is not so fun.


You totally miss the point.

It is the schools DIAGNOSING and PRESCRIBING.

Seriously.

They will name the drugs your kid must be on before they may return to school.

Mental illness needs to be treated, but it needs to be treated by professionals who have the training and ability to treat it. A school principle is not qualified.

[Dancing David]

You totally miss the point.

It is the schools DIAGNOSING and PRESCRIBING.

Seriously.

They will name the drugs your kid must be on before they may return to school.

And why did the kids have to leave the school?

Where and when did this occur?

How many cases are there?

You are making some really strong accusations. And at least in my state this is illegal. And would be a clear violation of the 'due process' in special education. It costs big money and time when you do that.

There are teachers and staff who ask parents to get their kids evaluated. And make recomedndations that are unwarranted. You should not treat a child who lives in an abusive home for ADHD until you can evealuate them more carerfully.

What exactly are you talking about?

When, where and for what?

I can think of at least twenty kids in my schools would definitly be able to benefit from treatment (out of a school of 700), they fidget all the time, they get out of their chairs, they interupt class, they distract other students, they disrupt class and they get sent out of class. All because they have ADHD and in fact will readily tell you that their symptoms inprove when they take their medication.

But guess what they don't do?


So what the Fred are you talking about?

Why did they have to leave school? What were their issues? Why was the school saying they had to take a medication? Are you sure they were not just saying they had to continue a treatment that had been successful? Especially if it was a student with bipolar disorder or intermittant explosive DO.

Where (state) and when.

Yes there are many , especially parents, who push their children to get medications. yes there are teachers who don't like having to do classroom management.

What are you talking about?


Mental illness needs to be treated, but it needs to be treated by professionals who have the training and ability to treat it. A school principle is not qualified.

But your cards on the table.

I work in a middle school with seven hundred student, in a town of 90,000 next to a twon of 40,000 in central Illinois.

Who told you these things are happening?
When did they tell you they were happening?
Where did they tell you these thinsg were happening?
Why was the child put out of the school, what did they do?